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States craft their COVID exit strategies

As Omicron fades and scientists consider when to declare COVID-19 endemic—and, therefore, here to stay—in the United States, governors in 10 states last week leapfrogged federal recommendations and dropped mask mandates.

One by one, governors and health officials in California, Connecticut, Delaware, Illinois, Massachusetts, Nevada, New Jersey, New York, Oregon and Rhode Island broke ranks and announced an end date for masking requirements in indoor public spaces such as grocery stores and restaurants and, in some cases, schools. They were joined this week by District of Columbia Mayor Muriel Bowser, a Democrat.

Cities, counties and school districts are free to maintain their own restrictions and requirements in those states.

Until now, those same states had ardently adhered to national COVID-19 guidelines from the federal Centers for Disease Control and Prevention.

The CDC is probably only a month or two away from declaring COVID-19 an endemic virus like a cold or flu that can’t be eradicated but is no longer a serious threat to most people, scientists and public health officials predict. Even so, the CDC has asked states to maintain COVID-19 restrictions until slammed hospitals can get back on their feet and declining transmission rates reach a low level and stay there for a few weeks.

Case rates in the blue states that decided to lift mask mandates last week are plummeting, said Dr. David Dowdy, associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. That’s primarily because they were among the first places in the country where Omicron surged, so they’re the first to see it dive.

“But now is not quite the time to pull the trigger,” Dowdy said of ditching mask requirements. “It will be coming soon, and when it does, we should base the decision on meeting certain milestones at the local level—not on some arbitrary dates.”

Still, polls indicate pandemic-weary Americans are desperate to get their old lives back. And the CDC has not yet said how the end of the pandemic would be measured. In a recent survey on behalf of the Kaiser Family Foundation, about three-quarters of Americans said they were tired and frustrated when asked about the current state of the COVID-19 pandemic.

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That, combined with worries about the effect of COVID-19 sentiments on upcoming elections and increasing difficulties enforcing mask rules, led the mostly Democratic governors to act, said Dr. Leana Wen, former Baltimore health commissioner and professor of health policy at George Washington University.

Why weren’t governors willing to wait for the CDC to make the call?

“They promised their constituents that pandemic restrictions would be removed as quickly as they went on. States have been asking the CDC for months for an off-ramp,” Wen said. “Governors are now saying they can’t wait for the CDC anymore.”

Like Dowdy and other scientists interviewed by Stateline this month, Dr. William Schaffner, professor of preventive medicine at Vanderbilt University School of Medicine, predicted COVID-19 would be under control in six to eight weeks. “People have been wearing masks for two years; why not wait a little longer?” he asked.

“The fear among public health professionals is that people will go about their lives in a carefree rather than careful fashion and there will once again be an upsurge in disease and hospitalization,” he said. “We’ve seen this movie before.”

Masks off

New Jersey Democratic Gov. Phil Murphy led a wave of announcements last week when he declared that masks would no longer be required for students, teachers or visitors in schools and child care centers starting March 7.

As the week progressed, Connecticut Democratic Gov. Ned Lamont lifted the state’s school mask requirement effective Feb. 28. And Delaware Democratic Gov. John Carney ended a broad statewide indoor mask mandate Feb. 11, but postponed ending school mask requirements until March 31 to give parents more time to get their kids vaccinated.

Oregon Health Authority officials said they would end all mask requirements in public places, including schools, no later than March 31.

California’s public health agency said only unvaccinated people would have to wear masks in public settings starting Feb. 16. The agency said Monday it would reevaluate the school mask policy on Feb. 28.

New York Democratic Gov. Kathy Hochul made a similar announcement, lifting mask requirements for businesses Feb. 10, but postponing until early March a decision on whether to end the state’s school mask mandate.

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Illinois Democratic Gov. J.B. Pritzker said mask requirements for public places would be dropped Feb. 28, but that school mask mandates would remain in place while his administration seeks to overturn a court ruling that questioned his legal authority to require masks and other COVID-19 measures in schools.

In Massachusetts, Republican Gov. Charlie Baker announced masks would no longer be required in schools as of Feb. 28. In Rhode Island, Democratic Gov. Dan McKee announced plans to end mask mandates in schools starting March 4, and ended the statewide mask requirement for all other indoor public spaces Feb. 11.

And Nevada Democratic Gov. Steve Sisolak lifted all mask-wearing requirements in public places, including jails and prisons, effective Feb. 10. He said school districts could set their own masking requirements for students and teachers.

Under pressure from the state legislature, Pennsylvania Democratic Gov. Tom Wolf lifted school mask requirements in January, leaving it up to school officials to decide whether the face coverings would be required.

Health experts and public health officials are optimistic that the pandemic will continue to wind down this year. But many of them say that now—in the middle of winter with hospitals full and COVID-19 transmission still high almost everywhere—is not the best time to let down our guard.

“If this were a flu outbreak,” Schaffner said, “we would say it was still in full swing.”

Local decisions

In the blue states that lifted mask mandates and other COVID-19 restrictions last week, cities and counties are free to continue existing requirements or tighten them depending on local data. Los Angeles County, for example, started requiring high-quality masks for teachers and students in January and maintained its countywide indoor mask mandate after Newsom lifted the statewide mask mandate.

Similarly, in states that never set statewide mask mandates, cities, counties and school districts have been determining when masks and other precautions are needed since the pandemic began.

Likewise, in Arizona, Arkansas, Iowa, South Carolina and Tennessee, where governors enacted prohibitions on mask mandates but courts upheld masking requirements, local health agencies and school districts have been deciding when COVID-19 protections are required.

And in states such as North Carolina that had mask mandates in the beginning of the pandemic but let them expire, school districts and local health agencies have taken on the responsibility of deciding when masks should be required.

Epidemiologists agree that decisions about when to ease COVID-19 controls should be made at the local level, based on hospital and intensive care unit capacity, vaccination rates, test positivity rates and local transmission.

Schaffner said he’s more worried about COVID-19 spreading in Tennessee, which has one of the lowest vaccination rates in the country, than in a state such as Massachusetts, where vaccination rates are high.

In Maryland, Republican Gov. Larry Hogan last week asked the state Board of Education to rescind its school mask requirement. Maryland ended its statewide indoor mask mandate in May.

But enforcing local COVID-19 restrictions that are more stringent than state policies has proven difficult over the course of the pandemic, said Adriane Casalotti, chief of public and government affairs at the National Association of County and City Health Officials. In many cases, local health officials have experienced public pushback, animosity and noncompliance.

On top of that, the COVID-19 message right now is complicated, Casalotti said. “We’re asking people to assess their own risk and make their own decisions about wearing a mask. When people don’t know what to do, they call the local health department.”

While the Biden administration and public health experts say they want governors to wait a few weeks or months before signaling to their residents that the pandemic is over, the potential for serious harm now from abrupt local decisions is relatively low, Dowdy said.

“When you’re talking about the rise of an epidemic, failure to control a contagious disease for even a few days can make a huge difference,” he said. “But when you’re talking about the fall of an epidemic wave, a few days or weeks won’t make that much difference.

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“We’ve already taken masks off and put them back on earlier in the pandemic,” Dowdy said. “People complained, but they eventually did it.”

Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.

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Gene Moreland/TucsonSentinel.com

As COVID-19 transmission plummets, some states are lifting mask mandates and other pandemic restrictions.